Having a newborn is challenging at the best of times, but during forced isolation and in a climate of fear and uncertainty, it can become overwhelming.
The coronavirus pandemic is setting up our communities for genuine mental health concerns. This may be especially true for new parents. When will 'normal' life return? How will I pay for diapers and baby food? Will my mom be able to help us now? What if my baby or my family get COVID-19? Unfortunately, no one knows the long-term impact or answers just yet.
Most families have built a network of social support by the time they have their first child—if they don't already have a support system, they develop one through various baby classes and groups set up for parents. The creation of the village can be instrumental to the mental health of new parents. Social distancing, the lockdown of cities, and isolation will inadvertently affect the type of support available.
Now more than ever, we have to take care of our mental health, particularly new parents. Postpartum depression will likely rise during this pandemic, so people need to understand what it is and what can be done about it.
What is postpartum depression (PPD)?
Postpartum depression is a mood disorder that occurs among parents or the caretakers of a newborn.
Depression is an unseen illness, which is why it can often go undiagnosed. But certain clues can help identify someone who needs help. There is no one feeling that categorizes depression. Instead, a person can have a range of emotions that may include:
- Sadness, unhappiness or a low mood for two or more weeks
- Lack of interest to do anything
- A lack of interest in social life or work
- Difficulty bonding with their baby
- Difficulty concentrating or making decisions
- Frightening thoughts, for example, about hurting their baby*
- Decreased energy and feeling tired all the time
- Sleep problems at night or feeling sleepy during the day
- Irritability, increased emotional reactivity and feelings of guilt
*If you feel like you want to hurt yourself or someone else, call 9-1-1, 24/7 CRISIS Resolve Network (1-888-796-8226), or seek emergency care.
The presence of one of the above does not mean the person is definitely depressed, however. For example, sleep problems and tiredness may be due to taking care of the baby at night, rather than depression. Additionally, difficulty bonding may be due to problems the mom is experiencing with feedings.
It is important not to confuse or attribute these feelings to "just" the baby blues.
- Feeling tearful, low or emotional
- Irritability and moodiness
- Feeling anxious
While the baby blues have overlapping symptoms, it is much more prevalent (80% of women will experience the baby blues), but it lasts only 10 to 14 days. If your baby blues symptoms last longer than that, it could be PPD.
(Check out this article for more information on the baby blues: Is it baby blues or postpartum depression? How to tell the difference.)
Ultimately, know that it is not your job to diagnose yourself. All you need to do is get on the phone with a therapist. They can help you figure out if what you are experiencing is typical or if concern is warranted.
What causes postpartum depression?
In short, we don't know exactly.
Researchers and providers have identified risk factors associated with postpartum depression and encourage proactive measures prior to birth for intervention.
Some of the most common associated risk factors are similar to those that have been put into place to keep us safe from the coronavirus:
- Lack of support from friends or family
- Recent stressful life events such as bereavement or being diagnosed with Covid-19
- A poor relationship with your partner
- Experiencing the baby blues
People at most risk are those who already have a history of mental health problems, particularly depression, especially if it was present during pregnancy. Furthermore, many people have lost their jobs, paid leaves, and/or medical insurances that impact their postpartum experience for their families. This is an additional new high stressor for many parents with infants during the pandemic.
Why is postpartum depression awareness critical during the pandemic?
Identifying the presence of postpartum depression is essential because undiagnosed PPD will not fix itself or just go away—and it can have devastating consequences: Maternal suicide remains a top cause of death among mothers.
Diagnosis is also important because treatment options for postpartum depression are numerous.
While depression is still under-recognized in most countries, we are seeing some improvements. In recent times, there has been a significant effort to try and remove the stigma around mental health conditions. The fear of being perceived negatively, the fear of the child being taken away, and the societal stigmas, all contribute to why women hesitate to seek help.
If you are concerned that you may have PPD, please speak to a therapist today.
What's important to remember about PPD?
1. It's not your fault; postpartum depression can happen to anyone.
2. Being depressed does not make you a bad parent. Full stop.
3. Babies are only taken into care away from parents in very exceptional circumstances. Almost always, babies stay right with their family as a parent is getting treatment for PPD.
4. It's common. Worldwide, 13% of women will have PPD within the first year of giving birth.
5. It can affect fathers and partners, not just women who gave birth!
6. Depression is an illness like any other visible or physical illness.
What are the common treatment options for PPD?
Most people associate treatment for depression with medication. However, in most cases, medication is not the first line of treatment for depression.
Over the past 40 years, significant research has discovered evidence-based treatment options for depression, and we are now fortunate enough to have a range of very effective options used in the treatment of PPD.
Medication usually takes one to two weeks to work and is continued for at least six months. The exact mechanism is unknown but is believed to work by increasing levels of chemicals, like serotonin and noradrenaline in the brain.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) focuses on challenging a person's thought process and patterns in order to avoid cognitive distortions (thoughts, beliefs and attitudes) as well as unhelpful behaviors, such as excessive worry, anxiety, isolation and detachment. This change in perception helps to improve emotional resilience, develop personal coping strategies, and avoid withdrawal.
A recent meta-analysis found no statistically significant difference in effectiveness between second-generation antidepressants and CBT.
Mindfulness-Based Cognitive Therapy
Jon Kabat Zins, the founder of the Mindfulness-Based Stress Reduction program, describes mindfulness as "moment by moment awareness, non-judgmentally." The aim is to interact and be aware of one's thoughts that may be unhelpful through meditation. Through mindfulness, a person learns to accept and see unhelpful thoughts, but does not engage with them; this empowers them to not get caught up in any one moment, past or future.
Too often, we get stuck in our past or have excessive worry for our future. Was this the right time to have a baby? Why did I change jobs? What will happen in the future? When will 'normal' life resume? This inadvertently has a direct effect on our present mood and wellbeing.
Evidence shows that people who practice mindfulness meditation report feeling calmer and free from their own emotional baggage. Most importantly, they feel free to be more compassionate to themselves and others.
MBCT was created by Zindel Segal and Mark Williams. Therapy is usually eight weeks long, with sessions once a week. There are six guided meditations that can be found on the mbct.co.uk website that have been recorded by Mark Williams. Alternatively, you can buy the book The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, which includes the Guided Meditation Practices CD.
MBCT is particularly effective in providing people who previously have suffered from depression with the tools to prevent a relapse.
Interpersonal Therapy (IPT) was a practice first developed at Yale in 1969 and is considered to be high-impact psychotherapy. Unlike CBT, IPT does not focus on thoughts but instead focuses on the belief that our relationships affect our moods. It is a highly structured program that has been shown to be as effective as medication or CBT.
The goal of IPT is to identify issues and problems in interpersonal relationships; this can be particularly relevant to new parents as 67% of couples see marital satisfaction decrease after having a baby.
IPT aims to teach the skills addressing this, thereby improving relationships, decreasing interpersonal distress, and alleviating depressive feelings.
One of the most straightforward psychological therapies used is Behavioural Activation (BA). BA has been seen to be as effective as CBT but works differently.
Often during depression, people stop doing activities that they used to enjoy and become more withdrawn. This, in turn, reinforces low mood. BA aims to increase your contact with positively rewarding activities. This could be something as simple as returning to those activities that used to have a positive impact on mood. For example, scheduling in Zoom or WhatsApp dates with friends, putting aside time to read the books you enjoy, or taking time out for some self-care.
Self-help often suits full-time parents and caretakers, as this does not require fixed appointments.
Self-help is learning done through workbooks, apps or computer courses—it can be guided by a therapist but doesn't have to be. The aim is to empower and provide you with the information and skills to be able to work on your thoughts in your own time.
Reframing expectations of parenthood based on your truths, acknowledging the difficulties of transitioning into a new stage, and giving yourself permission to take breaks can provide emotional relief. Reducing the amount of social media exposure temporarily can also decrease anxieties related to pressure, your mothering identity, and overall well being.
Self-help apps are available, as well as books like The Compassionate Mind Approach to Postnatal Depression by Roslyn Law, which is highly recommended.
Getting enough sleep, eating healthy and exercising can all contribute to a healthy lifestyle and, in turn, our mental health. An unhealthy lifestyle with excessive alcohol consumption or smoking has been seen to contribute to worsening symptoms of depression.
Exercise helps to improve our mood through the release of endorphins. Walks or runs with your baby in a carrier or stroller are great ways to get a bit more exercise in the day. Depending on where you live, this may be difficult due to different responses to COVID-19, but if possible, parents or carers should try to get out of the house every day, at least for a walk. If not, find a way to get some movement inside.
How to get help for postpartum depression?
The hardest thing by far is making that first step, but once you have, know that we are there to help. Speak to your doctor or midwife, or find a therapist through your insurance company. There are also many telehealth services available. Even in these unprecedented times, most providers are quite apt at doing consultations over the phone.
Here are 5 ways to help friends with PPD during the pandemic
Even if you are not suffering from PPD, a friend might be.
If there is anything we have learned during this pandemic, it is that life and relationships do not just stop—they may look different, but our need for social connection can continue in other forms. Support can be virtual or from a distance.
Here are a few ways you can help:
- Phone calls, texts, Zoom, Houseparty, WhatsApp—anything that lets them know you are there for them.
- Offer to do their shopping while you do yours.
- Leave a homemade meal at the doorstep.
- Simply ask them how you can help.
- Regularly check up on them and their mental health. Having open discussions on mental health creates a safe space for someone to talk about their worries and concerns and may be more effective in achieving the same outcome.
Please remember that you are not alone in this. Help is available and effective, and you get back to feeling well very soon. For additional support and resources, the experts at Allegheny Health Network (AHN) are here to help.
This article was sponsored by Allegheny Health Network (AHN). Thank you for supporting the brands that support Motherly and mamas.